It is my uncomfortable belief that medicine as it is practised today hardly contributes to dying well, and its contribution to living well is grossly overrated by doctors and patients alike. Looking back into history, it would appear that people have always been pretty good at the simpler tasks of medicine, such as dealing with fractures and wounds. As to the many other ailments, there was an extensive use of herbs and less pleasant concoctions which occasionally hit a target people didn't even know existed.Apart from that there was a lot of vomiting, purging, cupping, praying, blessing, sacrificing, laying on of hands, going on a pilgrimage, showing it to the moon, magnetising, mesmerising or hypnotising, and then all of a sudden we arrived in the 19th century.

It is my uncomfortable belief that medicine as it is practised today hardly contributes to dying well, and its contribution to living well is grossly overrated by doctors and patients alike. Looking back into history, it would appear that people have always been pretty good at the simpler tasks of medicine, such as dealing with fractures and wounds. As to the many other ailments, there was an extensive use of herbs and less pleasant concoctions which occasionally hit a target people didn't even know existed.Apart from that there was a lot of vomiting, purging, cupping, praying, blessing, sacrificing, laying on of hands, going on a pilgrimage, showing it to the moon, magnetising, mesmerising or hypnotising, and then all of a sudden we arrived in the 19th century.

Every reasonably educated doctor would like to say that it wasn't until the 19th century that our profession gained a solid footing. What we describe as scientific medicine is a view of the body and its functioning which developed in the first half of the 19th century. A development which quickly gathered momentum in one of the most remarkable upheavals of our social and physical lives.

One could speak after 1850 of the rise and rise of Modern Medicine. The study of the anatomical basis of the symptoms of disease. The discovery of the bacterial causes of diseases. The methods developed to avoid bacterial contamination. The discovery of anaesthesia, antibiotics, insulin, increasing surgical sophistication, psychotropic medication, vaccination, open-heart surgery, kidney transplants, hip replacement, the pill, traumatology, intensive care treatment and so on - but no ad infinitum.

Because medicine has become so clever, it would seem, at removing suffering that the many kinds of suffering against which it is powerless have fallen into disregard.

We are so intoxicated by the marvellous success of medicine in certain situations we believe this to be applicable to all other situations as well. So we think that a patient's complaint will, after diagnostic procedures, always be traced to a diagnosis and a treatment will ensue.

In fact, in many cases we get stuck after diagnosis, for we cannot treat a stroke, or Alzheimer's, or Parkinson's disease, or multiple sclerosis, or motor neurone disease, or schizophrenia, or osteoporosis, or nicotine addiction, or most famously and least believed of all: we cannot cure cancer. The actual contribution of medicine to living well is of course impossible to assess. But what doctors and patients think about this contribution is beyond reason and unfounded. Ludwig Wittgenstein said in the Tractatus: "We feel that even when all possible scientific questions have been answered, the problems of life remain completely untouched".

I think what Wittgenstein means is this: around suffering there's always the question why? So when a patient asks: why am I to die? And the doctor responds with a lengthy disquisition on the insufficiency of her coronaries, the accumulation of fluids in the lungs, the patient will soon interrupt all this physiology and will say: never mind all that, I meant why me?

In the 19th century, scientific medicine was born. Its success in alleviating suffering was so immense as to leave us all over-impressed. However, not all physical suffering can or ever will be taken away by medicine, and yet, we act as if medicine can do this, or will soon be capable of doing this. Paradoxically, this leads to increased suffering, especially in the hour of death, when the scientific analysis of bodily events ignores the sadness of parting from life. Our real questions, in Wittgenstein's sense, are not scientific. And we would do well, when talking about choices around death, to be aware of the understandable but therefore no less harmful blindness of one of the principal actors in the last act of life - the doctor with his scientific obsession. Finally, what is said of life, I believe also applies to speeches: all's well that ends!